Private Contract Sample for Providers that Opt Out of Medicare

Published 12/31/2020

If you have opted out of Medicare, you are required to have a private contract with the beneficiary, in addition to filing for an affidavit with all Medicare contractors. The affidavit must be filed within 10 days of entering into the first private contract with a Medicare beneficiary. A sample contract (PDF) is available to ensure you are meeting the requirements as an Opt-Out Provider. 

Please refer to the article below for additional requirements.


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